Healthcare Provider Details

I. General information

NPI: 1841345162
Provider Name (Legal Business Name): ANAND PRAKASH, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 02/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3975 JACKSON STREET SUITE #105
RIVERSIDE CA
92503-3945
US

IV. Provider business mailing address

3975 JACKSON STREET SUITE #105
RIVERSIDE CA
92503-3945
US

V. Phone/Fax

Practice location:
  • Phone: 951-359-6030
  • Fax: 951-359-6032
Mailing address:
  • Phone: 951-359-6030
  • Fax: 951-359-6032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA26623
License Number StateCA

VIII. Authorized Official

Name: DR. ANAND PRAKASH
Title or Position: DOCTOR/OWNER
Credential: M.D.
Phone: 951-359-6030